Request For Short Term Facilities Usage

 

Please note that each field below will only accept a maximum number of characters. Larger comment fields allow for a maximum of 500 characters to be entered (view the top of the page for a countdown).Smaller fields allow for a maximum of 50 characters entered (view the top of the page for a countdown).Countdown will adjust automatically per field


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Hosting Organization
(Legal Name) & 501c3 #
Street Address
City, State, Zip Code

Fax Number
   
Event Title
Event Content
Event Agenda

Requested Date(s)
Requested Start Time(s)*
Requested End Time(s)*

* Times must include set-up and take down
   
Event Coordinator Name
Event Coordinator Phone
Event Coordinator Email
Malcolm X College Contact (if any)

Estimated Number of Attendees
Number of Staff estimated to work event

Is this event:

Inside Outside

 
Comments related to date, time, or attendees

 
Seating Preferences:
If you know the room you would like to use please list it here:
Theater Style:


Theater
Lecture Hall
Sports Complex
Classroom

Rectangular Tables Y N(
Seating on both sides?
Round Tables
No Tables
Seating Comments

Room Furnishings
Will you need: Stage Podium Backdrop
Furnishing Comments:

Maintenance Needs:
Will you need: Extension cords Flatbeds/Dollies
 
*Please note: banners, poster, or flyers that need to be affixed must be received by maintenance at least 48 hours prior to the event
   
Maintenance Comments:
Audio Visual Needs:
Will you need: Projector
Computer (Please identify your needs below)
Internet (Please identify your needs below)
Sound System (please identify your needs below)
Microphone
TV/VHS Playback
TV/DVD Playback
Overhead Projector
Screen
Audio Visual Comments:

Food & Beverage Needs:
Will you be serving food?

Yes No

 
Please Identify your vendor and the type of food served:
Proof of insurance and license required
*Please note your food vendor will be required to provide proof of license

 
 
Type of Advertising:
DO NOT ADVERTISE UNTIL YOUR EVENT HAS BEEN CONFIRMED
   
Does your event require special accommodations (include handicap accessibility requirements)?